Vascular cognitive disorders and depression after first-ever stroke : the fogarty-Mexico stroke cohort

Q2Q1Artículo original284-289Background and Purpose: Stroke is the major cause of vascular behavior and cognitive disorders worldwide. In developing countries, there is a dearth of information regarding the public health magnitude of stroke. The aim of the Fogarty- Mexico cohort was to assess the prevalence of vascular behavioral and cognitive disorders, ranging from mild vascular cognitive impairment (VCI) to vascular dementia (VaD), in a cohort of acute first-ever symptomatic stroke patients in Mexico. Methods: A total of 165 consecutive, firstever stroke patients admitted to the National Institute of Neurology and Neurosurgery in Mexico City, were included in the cohort. Patients were eligible if they had an ischemic stroke, primary intracerebral hemorrhage, or cerebral venous thrombosis (CVT). Stroke diagnosis required the presence of an acute focal deficit lasting more than 24 h, confirmed by a corresponding lesion on CT/MRI. Stroke severity was established with the NIH Stroke Scale. The pre-stroke functional status was determined by the IQCODE. Three months after the occurrence of stroke, 110 survivor patients returned for follow-up and were able to undergo functional outcome (modified Rankin scale, Barthel index), along with neurological, psychiatric, neuropsychological, laboratory, and imaging assessments. We compared depression, demographic, and clinical and imaging features between patients with and without dementia, and between patients with VCI and those with intact cognition. Results: Of the 110 patients (62% men, mean age 56 ± 17.8, education 7.7 ± 5.2 years) 93 (84%) had ischemic strokes, 14 (13%) intracerebral hemorrhage, and 3 (3%) CVT. The main risk factors were hypertension (50%), smoking (40%), hypercholesterolemia (29%), hyperhomocysteinemia (24%), and diabetes (22%). Clinical and neuropsychological evaluations demonstrated post-stroke depression in 56%, VCI in 41%, and VaD in 12%; 17% of the latter had pre-stroke functional impairment (IQCODE >3.5). Cognitive deficits included executive function in 69%, verbal memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054) older age (mean age 65.6 years vs. 49.3, p < 0.001), diabetes (p ≤ 0.004), illiteracy and lower education (p ≤ 0.001), and PSD (p = 0.03) were significantly higher in VCI-VaD compared with cognitively intact post-stroke subjects. We could not demonstrate an association with lesion site and distribution of the cognitive deficits. Conclusions: The Fogarty-Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable

Partner notification for sexually transmitted infections in developing countries: a systematic review

<p>Abstract</p> <p>Background</p> <p>The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs.</p> <p>Methods</p> <p>The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries.</p> <p>Results</p> <p>Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes.</p> <p>Conclusions</p> <p>STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.</p

¿Se puede medir el estigma sobre aborto a nivel comunitario? Construcción de una escala validada en México

Presentación en la 4ta. Conferencia Regional del CLACAI. Reafirmando el legado de Cairo: Aborto legal y seguro. Lima, 21 y 22 de Agosto de 201

Metodología para medir los efectos de la aplicación de estándares sobre la industria de los medios de pagos en el mercado chileno

Cada vez juegan un rol más relevante en nuestra vida las tecnologías de información, desde nuestros hogares hasta las empresas y gobiernos acceden a grandes volúmenes de datos e información, las comunicaciones ya no tienen impedimentos de distancias, un comprador y un vendedor puede estar en cualquier lugar, un producto que es adquirido en un comercio en Santiago a través de un medio de pago (tarjeta de crédito) en menos de un segundo la transacción va desde Chile a solicitar autorización en Singapur para ser aprobada. En la sociedad tanto oferentes como demandantes cuentan con información disponible en línea para la toma de decisiones. Existe una mayor apertura e integración económica iniciada con las redes comerciales, donde existen enfoques regionales y multilateral, que han impulsado la apertura del comercio y la integración económica. Son múltiples los tratados de libre comercio que apoyan al desarrollo económico, donde las crisis mundiales han afectado tanto las economías como el transporte, considerando que en el comercio internacional cerca del 90% se desarrolla a través de los puertos, es importante identificar relaciones entre el desarrollo de los medios de pago y el comercio electrónico a través de los puertos. Nuestra investigación busca integrar tanto aspectos de investigación científica como como investigación aplicada, de modo que sea un aporte al día a día de empresas en el sector de los medios de pago en Chile y quienes diseñan y definen la aplicación de normas y estándares. Esta tesis plantea una metodológica para analizar las relaciones entre la aplicación de estándares y sus efectos en la industria de los medios de pago en Chile. Este trabajo de investigación nos permitirá identificar entorno, variables que intervienen y evolución del mercado de los medios de pago, a través de un relevamiento del estado del arte de los medios de Pago en la industria Bancaria chilena. Buscaremos en el mercado de los medios de pago en la industria Chilena - sector Bancario, relaciones entre la aplicación de estándares y sus efectos en los volúmenes transaccionales, analizaremos las tendencias de los medios de pago y el desarrollo comercial del Puerto de Valparaíso. Se busca a través de esta metodológica poder mejorar la toma de decisiones en la industria de los medios de pago en Chile con una mejor gestión y uso de recursos. Every day information technology plays a greater role in our lives, from our homes to businesses, to how governments access large volumes of data and information. Communication is no longer hindered by distances, as a buyer and seller can be anywhere. A product that is purchased in a shop in Santiago through a payment option (credit card) in less than a second, a transaction will request authorization from Chile to Singapore to be approved. In this society both buyers and sellers have access to online information that is available for decision making. There is greater openness and economic integration that has begun within the commercial networks, in which there are regional and multilateral approaches that has helped expand trade and economic integration. Likewise, there are numerous free trade agreements that support economic development; however, the global crisis has affected economies like transportation. In regards to international commerce about 90% is developed through the ports, considering that the former is important to identify the relationships between the development of the payment options and e-commerce at the ports. Our research aims to integrate both the scientific research and applied research aspects, so that this will be a contribution to the day to day business for the payment options in Chile, and for those who design and define the application of norms and standards. This thesis offers a methodology to analyze the relationships between the application of standards and its affects in the industry of payment options in Chile. This research will allow us to identify the environmental variables that intervene and evolve the market of the payment options, through the analysis of the state of the art in the payment options in the Chilean Banking industry. In the market of the payment industry options we have looked specifically at the Chilean Banking industry and the relationship between the application of standards and their impact on transaction volumes. In addition, there has been an analysis of the activity of the payment options and wire transfers in the maritime industry in Valparaíso in order to define the feasibility of a model that allows us to relate these effects in these markets and the application of standards. We have searched the Chilean banking industry for the relationships between the application of standards and its effect on transaction volumes, in order to analyze the trends in the payment options and the commercial development at the Port of Valparaiso. Therefore, through the use of this methodology we look to be able to make better decisions in the payment options industry in Chile, with better management and use of the resources

Estimates of Induced Abortion in Mexico: What's Changed Between 1990 and 2006?

En México,donde el aborto inducido en gran parte continúa siendo ilegal y clandestino,contar con datos confiables sobre su incidencia y la morbilidad relacionada es crítico para fundamentar las políticas y programas.La única estimación nacional disponible sobre aborto es para 1990; y,desde entonces, los cambios demográficos y socioeconómicos probablemente han afectado su incidenci